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J Med Internet Res ; 23(2): e22790, 2021 02 19.
Article in English | MEDLINE | ID: covidwho-1574794


BACKGROUND: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. OBJECTIVE: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. METHODS: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. RESULTS: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. CONCLUSIONS: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider.

COVID-19/psychology , Emergency Shelter/methods , Intimate Partner Violence/psychology , Quality Improvement/standards , Remote Consultation/methods , Telemedicine/methods , Adult , Female , Humans , Male , Pilot Projects , Pregnancy , SARS-CoV-2
Journal of Public Policy & Marketing ; 40(1):108-110, 2021.
Article in English | ProQuest Central | ID: covidwho-972524
JAMA Intern Med ; 181(4): 450-460, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-965464


Importance: Case-based surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely underestimates the true prevalence of infections. Large-scale seroprevalence surveys can better estimate infection across many geographic regions. Objective: To estimate the prevalence of persons with SARS-CoV-2 antibodies using residual sera from commercial laboratories across the US and assess changes over time. Design, Setting, and Participants: This repeated, cross-sectional study conducted across all 50 states, the District of Columbia, and Puerto Rico used a convenience sample of residual serum specimens provided by persons of all ages that were originally submitted for routine screening or clinical management from 2 private clinical commercial laboratories. Samples were obtained during 4 collection periods: July 27 to August 13, August 10 to August 27, August 24 to September 10, and September 7 to September 24, 2020. Exposures: Infection with SARS-CoV-2. Main Outcomes and Measures: The proportion of persons previously infected with SARS-CoV-2 as measured by the presence of antibodies to SARS-CoV-2 by 1 of 3 chemiluminescent immunoassays. Iterative poststratification was used to adjust seroprevalence estimates to the demographic profile and urbanicity of each jurisdiction. Seroprevalence was estimated by jurisdiction, sex, age group (0-17, 18-49, 50-64, and ≥65 years), and metropolitan/nonmetropolitan status. Results: Of 177 919 serum samples tested, 103 771 (58.3%) were from women, 26 716 (15.0%) from persons 17 years or younger, 47 513 (26.7%) from persons 65 years or older, and 26 290 (14.8%) from individuals living in nonmetropolitan areas. Jurisdiction-level seroprevalence over 4 collection periods ranged from less than 1% to 23%. In 42 of 49 jurisdictions with sufficient samples to estimate seroprevalence across all periods, fewer than 10% of people had detectable SARS-CoV-2 antibodies. Seroprevalence estimates varied between sexes, across age groups, and between metropolitan/nonmetropolitan areas. Changes from period 1 to 4 were less than 7 percentage points in all jurisdictions and varied across sites. Conclusions and Relevance: This cross-sectional study found that as of September 2020, most persons in the US did not have serologic evidence of previous SARS-CoV-2 infection, although prevalence varied widely by jurisdiction. Biweekly nationwide testing of commercial clinical laboratory sera can play an important role in helping track the spread of SARS-CoV-2 in the US.

COVID-19/diagnosis , COVID-19/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 Serological Testing , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Prevalence , Seroepidemiologic Studies , United States/epidemiology , Young Adult
Journal of Public Policy & Marketing ; 40(1):108-110, 2020.
Article in English | Sage | ID: covidwho-965753
Journal of Public Policy & Marketing ; 40(1):83-88, 2020.
Article in English | Sage | ID: covidwho-964883
Preprint in English | medRxiv | ID: ppmedrxiv-20216077


BackgroundNasal pathogen detection sensitivities are often as low as 70% despite advances in molecular diagnostics. It has been suggested that this is linked, in part, to the choice of sampling method. MethodsA diagnostic test accuracy review for sensitivity, using recently developed Cochrane methods for conducting rapid reviews, and the PRISMA protocol was undertaken, with QUADAS-2 risk of bias assessments and meta-analysis of included studies. Sensitivities were calculated by a consensus standard of positivity by either method as the gold standard. Insufficient and/or inaccurate, cross sectional or anatomical site pooling methodologies were excluded. ResultsOf 13 included studies, 8 had high risk of bias, and 5 had high applicability concerns. There were no statistical differences in pooled sensitivities between collection methods for 8 different viruses, and neither with use of PCR, Immunofluorescence nor culture. In a single study, Influenza H1N1 favoured nasopharyngeal swabs, with aspirates having 93.3% of the sensitivity of swabs (p>0.001). Similar equivocal sensitivities were noticed in detecting bacteria. ConclusionsThe chain of sampling, from anatomical site to laboratory results, features different potential foci along which sensitivity may be lost. A sufficient body of evidence exists that use of a different sampling method will not yield more respiratory pathogens. The new Cochrane Rapid Reviews guidance helped rapidly answer this relevant and timely clinical question.

J. Public Policy Mark. ; 3(39): 257-265, 20200701.
Article in English | WHO COVID, ELSEVIER | ID: covidwho-604707